Case formulation is globally recognized as both a clinical and conceptual tool which is essential in psychotherapy as it aids in the diagnosis of underlying causes of a patient's complications. A formal clinical case formulation can be written or orally presented, which communicates the treatment plan and various conceptual frameworks and a detailed justification for the precise strategy (Thew & Krohnert, 2015). It fills the gap between treatment and diagnosis and provides insights into the explanatory, integrative, predictive, and prescriptive aspects of a particular condition. Subsequently, an integrative formulation approach combines the techniques and concepts of various therapy plans to treat unique mental health complications systematically. According to Pandita and Farmakiotis (2020), treatment planning entails the procedures or processes that the therapists will apply in serving a client and ensuring they accomplish the treatment objectives and resolve the issue. This paper will focus on coming up with a psychotherapy integrative case on manic episodes disorder of John Hopkins and his wife, with considerations of various literature reviews, measures, and theories of the prognosis of this condition.
Case Description
In this case formulation, the hyperactive and manic episodes of Hopkins, a family and businessman, will be examined and the effect on his marriage and career life. His wife had discussed with him the urge to visit a psychiatrist, as she had observed on several occasions, an unusual behavior with his mental condition. Hopkins had been hyperactive and creative but would talk to himself during the night before going to sleep. In the morning, he would have mood swings or sometimes experienced some events of stress and anxiety.
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Hopkins was hesitant to visit the psychiatrist, but his condition was getting from bad to worse. He started forgetting his brothers and cousins' names, which signed the start of an uncertain future with his social cognition problem. The signs and symptoms of manic episodes continued to manifest in Hopkins in a way that he was devoted to his work but would at some point lack concertation and lose interest in his likes and interests. After some time, Hopkins decided to visit the psychiatrist to inform him of his manic episodes experience.
When most people become depressed, they tend to feel sad, lose interest, hope, or pleasure in their involvement. Changes in sleep patterns trigger manic episodes, elevated levels of stress and anxiety, excessive use of alcohol and drugs, and seasonal changes; for instance, the individual might experience mania or hypomania in the summer (Allott & Van Rheenen, 2020). An intense feeling develops that makes one feel helpless and might last for days and result in one staying away from people due to elevated sadness. This necessitates proper medical care and intervention to reverse the condition.
Background of the Problem
When Hopkins was in the university, he exhibited some signs of depression. He had a weak outlook of life, self-hate, and inappropriate guilt. Hopkins had regularly engaged in angry outbursts with his peers. Additionally, he had complained of how he lacked sleep during the spring. His parents were not much attentive with his schooling life and often ignored his complaints. He declined substantially in his academic performance declined due to the unstable condition of his cognitive awareness. After his marriage, it was not until after his marriage that h started experiencing insomnia and getting distracted when going about his daily operations.
Medication Conflicts
At first, his tutors had concluded that Hopkins had stress and tried to talk him out of being stressed or depressed. However, after visiting the psychiatrist, he was diagnosed with manic episodes. This condition had persisted for five weeks, with Hopkins being reluctant to adhere to the treatment plan. In most scenarios, manic episodes are treated with the use of medications and psychotherapy. It necessitates the services of a pediatric specialist in psychology who will come up with a personalized treatment approach.
Signs of Manic Episodes
The risk factors associated with manic episodes are a first-degree relative with bipolar disorder, instances of high stress, such as loss of a loved one, and alcohol and drug abuse. Additionally, the signs of manic episodes include mood swings or hot tempers, insomnia, and the tendency of easily being distracted from a task which takes away the concertation (Moran, 2018). All these signs had been exhibited by Hopkins, who had disturbed his wife and his family members.
Additionally, increased hypertension, racing thoughts, and euphoria are additional symptoms of manic episodes. Mania episodes are also the thrilling moods of well-being, vigor, and cheerfulness. These spirits or moods can be at times so intense that one can mislay a connection with realism. Subsequently, the three stages of mania include delirious mania, acute mania, and hypomania. Lack of physical fitness and eating disorders are other causes of manic episodes. Hopkins had faced the mentioned signs and symptoms, which had aided his wife in recognizing the type of mental condition he was experiencing. He was prescribed various medications which had undesirable side effects of increased laziness and elevated weight.
Base Theory: Diathesis- Stress Model
In the case of Hopkins and his wife, the Diathesis-Stress model is the best theory that aligns with the manic episode condition. It is also referred to as the vulnerability stress approach, which is more of a psychological theory that seeks to explain a specific disorder and its trajectory (Salomon & Jin, 2020). Additionally, it tends to unearth the interaction and factors that exist between a predisposition vulnerability and causes of various life experiences. The term diathesis is a Greek word that means sensibility or a predisposition. It can be in the form of biological, psychological, or genetic. There is a wide range of variations between people's vulnerabilities and the progression of a disorder.
In the case of Hopkins, the Diathesis-Stress Model can be essential in equating its vulnerability to the development of his manic episodes. From his university years, his tutors and peers had concluded that he was stressed or depressed. His parents were less concerned about his condition, which later evolved to be manic episodes. Hopkins's condition had worsened due to his failure to seek an alternative from the psychiatrist for his condition. Some of the critical influences that impacted Hopkins's manic episodes entail prolonged stress, lack of sleep, and the ease of being distracted from his involvement.
Other Theories
Social Cognitive Theory
In the case formulation of John Hopkins and his wife, the other relatable theory is the social cognitive theory. It deals with psychosocial motivations and factors that influence health behaviors and approaches to enhance translatable, persistent, and sustained behavior change. Self-efficacy and result expectancies are the two determinants of human behavior according to the social cognitive theory. Hopkins's hesitant behavior to visit the psychiatrist had caused harm to his body resulting in manic episodes. The social cognitive theory considers a person's preceding conduct, thoughts, social and physical environment when forecasting the prospect behavior.
Relationship and Methods of Formulation
The relationship between manic episodes and the Diathesis-Stress Model and the social cognitive theory provides viable measures to be considered when formulating a psychotherapy case, like in the case of Hopkins and his wife. The Depression Anxiety and Stress Scale-21 Item is an essential measure globally used to assess anxiety and stress attacks in any psychological disturbance. It has the validity of coming up with solutions for individuals suffering from manic episodes. A scale rating of 21 is used to rate the patient from a systematically formulated questionnaire.
Additionally, the Rosenberg Self-Esteem Scale has the characteristics of 10 items essential for assessing the psychological state of the self-esteem of an individual suspected to have mental problems. This method focuses on understanding the problematic perceptions about an individual if they blame themselves for the various failure of life. It aids in exploring the hypothetical scenarios about a patient's outcome after treatment.
Virtual Reality Therapy is a paradigm that is essential in delivering the innovative mode of therapy involving individuals with mental health problems such as manic episodes. It concerns zoning the patients in a room with a generated virtual setting (North & North, 2016). With technology, the patient's mind is tricked into concertation that enables them to think about real-life experiences. This, in turn, triggers emotions that influence their behavior change. With advancements in technology, psychiatrists can apply such methods in examining the psychological disorders of patients with varying mental health problems.
Conclusion
Case formulation is a subject of interest in psychotherapy because of being a research tool in the results of psychotherapeutic work and as a utility in the clinical and conceptual perspective. The paper focused on the case of John Hopkins and his wife, describing his personality as an individual combating manic episodes. It explained various literature reviews, theories, and measures to combat manic episodes explained above and the signs and symptoms. The case description gave a complete explanation of the problem surrounding Hopkins. Due to his hesitation to seek help from a psychiatrist, Hopkins's manic episodes increases as his mental condition worsened. The signs of the manic disorders disturb the life of Hopkins and his wife, which entailed the ease of being distracted, lack of energy, and talking to himself before going to sleep.
Manic episodes are associated with mood swings of highs and lows. An individual with a state of mania is said to have sensory experiences of high energy and increased alertness. However, the ease of being disturbed between his involvements and a state of insomnia are other indicators of manic disorders. Subsequently, the Diathesis-Stress model serves as the base theory and explains the vulnerability and trajectory of the disorder. The social cognitive theory also relates and explains manic episodes since it focuses on the links between internal and external influences of human behavior. The Virtual Reality Therapy, the Rosenberg Self-Esteem Scale, and the Depression Anxiety and Stress Scale-21 Item are the measures to rate various psychotherapy disorders.
References
Allott, K., & Van Rheenen, T. E. (2020). The complexities of understanding cognitive trajectory in bipolar disorder. Bipolar Disorders , 22 (5), 534-535. https://doi.org/10.1111/bdi.12907
Moran, P. (2018). The beast in white’s jungle: Manic-depressive illness. Antonia White and Manic-Depressive Illness . https://doi.org/10.3366/edinburgh/9781474418218.003.0002
North, M. M., & North, S. M. (2016). Virtual reality therapy. Computer-Assisted and Web-Based Innovations in Psychology, Special Education, and Health , 141-156. https://doi.org/10.1016/b978-0-12-802075-3.00006-1
Pandita, A., Gil, R. M., & Farmakiotis, D. (2020). Call for action: Racial disparities in clinical research. Clinical Infectious Diseases . https://doi.org/10.1093/cid/ciaa1349
Salomon, K., & Jin, A. (2020). Diathesis-stress model. Encyclopedia of Behavioral Medicine , 655-657. https://doi.org/10.1007/978-3-030-39903-0_797
Thew, G. R., & Krohnert, N. (2015). Formulation as intervention: Case report and client experience of formulating in therapy. The Cognitive Behaviour Therapist , 8 . https://doi.org/10.1017/s1754470x15000641
